Malawi: Launching of Aunty Jane Hotline for safe abortion options and other sexual and reproductive health topics

Launching of Aunty Jane Hotline in Malawi

Aunty Jane Hotline has been launched in Malawi. Centre for Girls and Interaction (CEGI) organized the launching at Mimosa Court Hotel in Mzuzu northern of Malawi.

Aunty Jane Hotline is an Interactive Voice Response system, meaning women and girls can access information 24 hours a day, 7 days a week in English and Chichewa. Aunty Jane Hotline gives information on PPH prevention, contraception, unwanted pregnancy and abortion, among other sexual and reproductive health topics. Because abortion is a very stigmatized topic, the launch of this public hotline is an important step forward. Callers can leave a message or sms and get a call back from a trained operator if they have specific questions or want to speak with someone

http://auntyjanehotlinemalawi.weebly.com/index.html

Ask Aunty Jane today!

0884 773 300  or text 0884 773 310

 

Misoprostol Is a Game-Changer for Safe Abortion and Maternal Health Care. Why Isn’t it More Widely Available?

 

by Francine Coeytaux, Public Health Institute (PHI)

and Elisa Wells, Independent Consultant

May 28

 

http://rhrealitycheck.org/article/2013/05/28/why-arent-we-taking-advantage-of-the-potentially-game-changing-drug-misoprostol/  

 

Misoprostol: Have you heard about this small, inexpensive, and most importantly available pill that can save women’s lives? Pragmatic Brazilian women first discovered the potential of misoprostol (or Cytoteca, in their parlance) in the 1980s. According to the label on this widely used peptic ulcer drug, it was not to be taken during pregnancy as it could induce bleeding. Living in a country with very restrictive policies and little access to safe abortion services, they recognized the opportunity to circumvent the system and, by word of mouth, spread the word to other women about this easily obtainable pill that could help them safely end an unwanted pregnancy.

 

Thirty years later, women in countries around the world are beginning to do the same-continuing to spread the word, talking to each other about misoprostol, and trying to get their hands on these pills. The women who are accessing the drug in their communities and taking it by themselves have shown us that there are relatively few health risks involved with misoprostol. What began in Brazil as a natural public health experiment has been validated by rigorous clinical studies conducted by international groups such as the World Health Organization and Gynuity. These studies have shown that the use of misoprostol for abortion is very safe, especially when taken early on in the pregnancy; while not as effective as when taken in combination with mifepristone (another abortion pill), misoprostol taken alone will safely terminate 75 to 90 percent of early pregnancies when taken as directed.

 

Misoprostol has also been proven to have numerous other lifesaving properties, including the ability to prevent and treat postpartum hemorrhage and to induce labor. It is registered in more than 85 countries, usually as an anti-ulcer medication, and is used off-label by clinicians around the world for numerous reproductive health indications. In addition to these clinical uses, we are beginning to see positive public health outcomes from community-based use of misoprostol. In countries where abortion is restricted and women are using misoprostol, we have seen a reduction in infections. And in under-served communities, where women delivering at home are taught to take misoprostol immediately after delivery, postpartum hemorrhage is significantly reduced.

 

If we have a cheap and readily available drug that can prevent and treat the two largest causes of maternal mortality worldwide-postpartum hemorrhage and unsafe abortion-why have we not taken more advantage of this exciting technology? Given the global attention being paid to meeting the fifth Millennium Development Goal (MDG 5)-that of reducing maternal mortality-it is difficult to fathom why we continue to squander the opportunity misoprostol offers us.

 

The public introduction of any new technology takes time and is not easy; the introduction of emergency contraception is just one of the latest examples. Reproductive health advocates have been working for decades to increase women’s access to this safe, effective, and non-abortifacient technology. While much progress has been made around the world, the recent action of the Obama administration to prevent full over-the-counter access in the United States is a sad illustration of the hurdles women face in accessing reproductive health technologies. The hurdles we face in introducing misoprostol will be even higher given three inherent characteristics:

It has multiple indications, including abortion.

It is only “second best” to existing drugs, competing with a “gold standard.”

It can be used by women without the assistance of a provider.

The Challenge of Multiple Indications

Misoprostol’s greatest clinical asset-the fact that it can be used for numerous reproductive health indications-also poses enormous challenges for implementation. As mentioned, misoprostol has many uses: to both prevent and treat postpartum hemorrhage, to induce labor, to induce abortion, and for post-abortion care. But these multiple indications pose two major challenges for implementation, one political and the other educational.

 

The political challenge lies in overcoming the stigma of abortion. A survey we conducted in 2010 of organizations that were working with misoprostol for postpartum hemorrhage revealed that the second biggest barrier to the introduction of misoprostol was its association with abortion. To quote one respondent who was asked about the challenges and opportunities for its introduction: “Hypersensitivity of misoprostol as an abortifacient [is a barrier]. We see this in clinical providers, government officials, even donors-a disproportionate concern that if misoprostol were to be made available for PPH prevention and treatment, it would be used for abortion. This is a major obstacle in accepting misoprostol for other OB/GYN indications-the abortion stigma.”

 

This political fear is strong, despite the evidence that all indications of misoprostol use are potentially life-saving. And because of this fear, there is a great deal of sidestepping going on as organizations begin to introduce misoprostol at the community level for postpartum hemorrhage while trying to stay clear of its potential use for abortion. “We feel there is tremendous promise for use of misoprostol for [postpartum hemorrhage], so we do not want to jeopardize that application by highlighting the other indications,” said another respondent.

 

The political controversy only exacerbates the programmatic challenge of informing women, their partners, and their health-care providers of the different doses and the proper timing of administration needed for different indications. This is usually facilitated by the registration and labeling of products in appropriate doses for each of misoprostol’s various indications.  

 

But because the vast majority of misoprostol use is currently done “off-label”(it’s being used for an indication other than the one the product is registered for) there is an urgent need to find ways to get women accurate information about how to use it for the different reproductive health purposes. Mobile technologies are beginning to open the information door to some women, but challenges remain. We need to find ways of achieving a broader level of knowledge about correct use, and to help women differentiate between the proper uses for each indication, including abortion.

 

The Challenge of Competing Against a “Gold Standard”

For both indications-abortion and postpartum hemorrhage-misoprostol is the second best option, up against another drug long considered the “gold standard.” For abortion, the most effective medical abortion regimen is mifepristone combined with misoprostol; when used together, the success rate is 93 percent, and when misoprostol is used alone it is 78 percent successful. Thus, where mifepristone is available, such as in the United States, it is the drug of choice.

 

In the case of postpartum hemorrhage, injecting oxytocin is the first line of treatment because, when oxytocin is at full potency, it is more effective than misoprostol. But oxytocin, unlike misoprostol, needs to be refrigerated. As a result, the quality of the drug is easily compromised by exposure to heat-a problem in many Global South countries. Finally, the administration of oxytocin requires that the women deliver in a health-care facility, another “gold standard” established by the medical community.

 

In reality, in many places in the world, we are not meeting these “gold standards,” in spite of decades of trying to do so. Mifepristone is far from universally available, oxytocin stock-outs are common in many places and/or the quality has been compromised, and many women continue to deliver at home, without skilled attendants. In these situations, misoprostol is a very good alternative and even has the advantage of being in pill form, making home use possible and safe.

 

Which brings us to the third challenging characteristic…

 

Women Can Use it Without the Assistance of a Provider

Another survey respondent summed it up nicely: “This is a gender issue. Misoprostol faces this unbelievable barrier because it is a drug for women.”

Therein lies both the greatest opportunity and the greatest challenge.  

 

Misoprostol has the potential to be a game-changer when it comes to maternal health precisely because it can be used safely and effectively by women themselves. The foremost obstacle to achieving MDG 5 is the weak health-care infrastructures of many countries. Misoprostol offers the opportunity to circumvent this obstacle for two of the three principal causes of maternal mortality-postpartum hemorrhage and unsafe abortion. Yet despite growing evidence that women can safely and effectively take misoprostol by themselves, in their homes, for both uses, health-care practitioners are insisting on controlling access to the drug, viewing it as an important addition to their clinical tool kit and a service only they can “provide” instead of as a pill that can be used by women, to help themselves, with little or no assistance from a health-care provider. The failure to relinquish control over the use of misoprostol not only gets in the way of women who are intent on helping themselves, it risks negating the most attractive aspect of this new technology: it’s self-use properties. To quote another respondent to our survey: “Many people are more concerned about what might happen with an intervention (i.e., side effects) than what might happen without an intervention (i.e., maternal death). In this case, women are more likely to be harmed by omission of the intervention than from any danger posed by the intervention itself.”

 

Obviously, as we work to make misoprostol available at the community level we need to acknowledge that it is a powerful drug and that incorrect use can lead to serious consequences-such as uterine rupture during labor induction. While some would use this as an argument for placing restrictions on access, we see this as a call to put accurate and comprehensive information about its safe use into the hands of women.

 

The Way Forward

This week policy makers from around the world are gathering in Malaysia at the third Women Deliver Conference to continue to share ways of reducing maternal mortality. Misoprostol is the single-best opportunity to do just that. But the true potential of this simple and cost-effective technology lies in our willingness to abandon our “provider” frame and put the pills directly in women’s hands. Our challenge is to let women be the shapers and the users of this new technology, not the beneficiaries of what we can provide or what we think they need. Can we stop worrying about women’s “misuse” or “abuse” of misoprostol and show that we truly trust women with their own reproductive health care? Let us remember that it was women who discovered this drug in the first place, specifically to circumvent the weakness of the health-care system. Let us give them back this powerful tool and get out of their way.  Our responsibility is to ensure that women have easy access to the pills and all the knowledge necessary to use them effectively and safely.

 

El Salvador: woman denied life saving medical intervention

REQUEST FOR SOLIDARITY

 

El Salvador: woman denied life saving medical intervention

 

From: Amnesty International, 15 April 2013

 

http://www.refworld.org/docid/5177d9574.html

 

Beatriz is a 22-year-old woman with a high risk pregnancy who is being denied access to

life saving medical treatment that she urgently needs in El Salvador. Her life is at risk and

she is suffering cruel, inhuman and degrading treatment.

 

Beatriz suffers from health problems that put her life at risk while she is pregnant. She has a history of lupus, a

autoimmune disease in which the body’s immune system attacks the person’s own tissue. She also has other

medical conditions, including kidney disease related to the lupus, and she suffered serious complications during

her previous pregnancy. Beatriz has been diagnosed as being at high risk of pregnancy-related death if she

continues with the pregnancy. Three scans have confirmed that the foetus is anencephalic (lacking a large part of

the brain and skull). Almost all babies with anencephaly die before birth or within a few hours or days after birth.

 

Beatriz has been requesting the recommended medical intervention for over a month. Beatriz wants to live and has

requested an abortion. She is now 4 and a half months pregnant. The medical professionals have not acted in

accordance with her wishes as yet because they feel unable to terminate her pregnancy without the express

assurance from the Salvadoran government that they will not be prosecuted for administering the life saving

treatment she needs. Abortion is criminalised in all circumstances in El Salvador. Under Article No. 133 of the

Penal Code, anyone who provides, or tries to access, abortion services can face lengthy prison sentences.

 

The health professionals responsible for Beatriz’s care have requested permission from the authorities to proceed

with the treatment. As yet no response has been given. Anxiety and suffering increase for Beatriz and her family

every day as concerns for her survival grow. Beatriz has a one year old son. The physical and mental anguish she

is experiencing is contributing to her health condition.

 

Please write immediately in Spanish or your own language:

·           Calling on the authorities to prevent any further denial of treatment and ill-treatment and order the immediate

unfettered access by Beatriz to the life saving treatment she needs, in accordance with her wishes and the

recommendations of medical staff;

·           Urging them to immediately ensure that the health professionals are enabled to provide the treatment necessary

to save Beatriz’s life without the threat, risk or fear of criminal prosecution for doing so in accordance with Beatriz’s

wishes.

·           Urging them to decriminalise abortion in all circumstances and ensure safe and legal access by women and

girls to abortion services necessary to preserve their life or health, or if they are pregnant as a result of rape.

 

PLEASE SEND APPEALS BEFORE 27 MAY 2013 TO:

Minister of Health

Dra. María Isabel Rodríguez

Ministerio de Salud

Dirección postal: Calle Arce No.827,

San Salvador, El Salvador

Fax: +503 2221 0991

Email: mrodriguez@salud.gob.sv

Salutation: Dear Minister/Estimada

Ministra

 

President

Mauricio Funes

Presidente de la República de El

Salvador

Dirección postal: Alameda Dr. Manuel

Enrique Araujo, No. 5500,

San Salvador, El Salvador

Fax +503 2243 6860

Salutation: Dear Mr/ Estimado Sr

 

And copies to:

The Citizens Group for the

Decriminalisation of Therapeutic,

Ethical and Eugenic Abortion

Fax: +503 2226 0356 (say “tono de fax”)

Email: agrupacionporladespenalizacion@gmail.com

 

Also send copies to diplomatic representatives accredited to your country.

 

New website www.doctorsforchoiceireland.com

The website www.doctorsforchoiceireland.com has just gone live.

Doctors for Choice is an alliance of independent medical professionals and students advocating for comprehensive reproductive health services in Ireland, including the provision of safe and legal abortion for women who chose it.

We believe that women should be supported to make their own decision regarding their sexual and reproductive health and to manage their own fertility, with doctors and nurses providing expert advice and care without judgment, recourse to the law or fear of criminal sanction.

We welcome your support. If you are a doctor or a medical student we will gladly welcome you into membership. You can contact us at doctorsforchoice@gmail.com

Follow them on Twitter and Facebook.

 

e: doctorsforchoice@gmail.com

t:  @doctors4choice

f:   Doctors For Choice Ireland

w:  www.doctorsforchoiceireland.com

 

Inter-American Human Rights Commission to hold landmark hearing on abortion rights

 

 

3 March 2013

 

Ipas News

 

Inter-American Human Rights Commission to hold

landmark hearing on abortion rights

 

On Friday, March 15th, the Inter-American Commission on Human Rights will hold a landmark hearing on the negative impactof criminal abortion laws. It is the first time the IACHR will hear testimony on theharmful effects these laws have on the lives of young girls and women and their families in Argentina, Bolivia, Brazil and Peru.

 

Ipas and Ipas Bolivia, in collaboration with Women’s Link Worldwide, ISER/Brazil, Promsex/Peru, Argentina, the Special Rapporteurship on the Right to Sexual and Reproductive Rights/Dhesca Brazilian Platform and Asociación por los Derechos Civiles/Argentina, will present findings from legal research on the impact of abortion criminalization on women’s lives, health and criminal justice systems. These findings indicate that states are systematically violating women’s rights to health, equality and non-discrimination, privacy and due process of law. The organizations will present recommendations to the IACHR on measures to be taken by states to respect and protect women’s human rights.

 

Legal indications for abortion are extremely limited throughout Latin America, and several countries-Nicaragua, El Salvador, the Dominican Republic and Chile-have outlawed abortion entirely, even when necessary to save a woman’s life. Previous regional human rights decisions have called on states to ensure access to abortion in narrow circumstances-such as when a pregnancy threatens a woman’s health or if she’s been raped. This hearing will address the broader social and legal impact of criminal laws.

 

The hearing will be take place 11:30 a.m. at the IACHR’s Rubén Darío Room (8th floor), 1889 F Street, NW, Washington, DC. It will also be webcast live on IACHR’s web site. It will be conducted in Spanish, with translation available.

 

Argentina: Safe Abortion Hotline with Misoprostol

Great article in the Argentine newspaper Pagina 12, about a network of women, called Pink Rescue, who accompany other women in the use of misoprostol for safe abortion. They give information, advise about risks and help make sure the women get a checkup afterward.

Articulo excelente sobre Socorro Rosa servicio de acompañamiento de mujeres que están usando el misoprostol para abortar con seguridad. Dan información, consejan sobre los riesgos y ayudan a segurar que la mujer haga un examen de control despues.

http://www.pagina12.com.ar/diario/suplementos/las12/13-7899-2013-03-16.html

 

Northern Ireland: Mass Civil Disobedience in North Illuminates Role Of States In Abortion Discussion

http://www.wsm.ie/c/mass-civil-disobedience-abortion-northern-ireland

Workers Solidarity Movement

Mass Civil Disobedience in North Illuminates Role Of States In Abortion Discussion

Date: Mon, 2013-03-11 12:21

In an act of mass civil disobedience directly challenging the legitimacy of the state to regulate women’s reproduction against their own will, over 100 people in Northern Ireland under the banner Alliance for Choice have signed an open letter declaring they have taken, or supported others to take, a pill to induce an abortion.

The political action is designed to coincide with a vote in Stormont tomorrow that, if passed, would make it illegal for women to receive abortions in private clinics in the north. The proposed amendment to the Criminal Justice Bill is being pushed by fundamentalists within what’s traditionally described as “both communities.” The proposal to change the law was tabled by the DUP’s Paul Givan, who chairs the Stormont Justice committee, and the SDLP’s Alban Maginness both of whom will never get pregnant. The Alliance party and Sinn Fein will oppose the amendment.

The act of civil disobedience itself is interesting from many perspectives, not least the way in which a coherent analysis within the letter makes apparent the links between women’s reproductive autonomy and the social/political policies of austerity that function to increase poverty and social inequality within national borders. That analysis is shared by the Pro Choice movements in the south.

Its also throws into stark relief one of the ambiguities of public discussion around abortion in the south. Whilst looking northwards, mainstream media seems to have little problem in conflating religious, social and political perspectives with the function of the state itself. Its one I and other anarchist share, and the contested nature of political identity and structural oppressions that gave rise to both to the civil rights movements as well as the provos make help illuminate that. That the state itself is an ideological entity is a given and assumed, even as the workplace practices of contemporary journalism give little reward or encourage for this to be untangled and explored. Neither is the tactic of civil disobedience in examined beyond the word ‘protest’.

For example this act of civil disobedience forces the northern state – via its police force and criminal justice system – to act or not act in a public fashion. The political act of disobedience is calculated to illuminate and educate about unjust structures of social/political/economic power as well as forcing the state to act in ways that regardless of the specifics, all actors know the state will itself be judged upon by the wider public.

However when looking closer to home, this Irish state seems to be continually framed – and likes to present itself as – ideologically neutral, as if it were a paternal independent arbitrator between two opposing positions. But this self image is patently false and can only be sustained under a social imagination that separates out abortion from the state’s historical role in the systemic abuse of women. But that’s simply not tenable to an increasingly political literate population, nor is it to the growing feminist movements on the island. The state is patriarchal in so far it has continually reproduced social conditions of inequality against women.

The Catholic Church has seen a massive diminishing of it social power, a direct result of the breaking of silence surrounding the systemic brutality that enforced its cultural weight in Irish society. Its “socially conservative” (read deformed, sexually repressive and violent) dogmatism, simultaneously anti-women, anti-homosexuality, is being challenged by an increasingly counter-hegemonic discourse. Woman in the pro choice movements are no longing pleading for control over their own bodies from a church and state nexus which have previously deemed itself the only legitimate authority that can dispense or renege on that autonomy. Many are, quite sensibly, demanding complete autonomy for themselves and each other.

Also the narrative that ‘abortion debate’ revolves around two opposing yet valid abstract moral positions is itself a mispresentation. There is no emotional or intellectual equivalency between the positions of “I dont want to be forced to remain pregnant against my will” and “You should be forced to remain pregnant against your will because I think abortion is ‘bad’”. I have yet to hear a anti abortion argument that doesn’t relegate women’s existence to forced birthing factories. Appeals to God and a paradigm of ethics and morals founded upon his (yes of course his) existence can of course can be made – and as an anarchist I support the freedoms that facilitate that – but they should be given no greater intellectual weight that the musings of Thomas the Tank engine or other fictional entities.  The function of suppressing women’s right to bodily integrity and reproductive choices does need a meta philosophy to justify itself. It is not to role of critically thinking, emotionally literate human beings to do that however.

If you align yourself to the Catholic Church you need to get used to the idea that many people see this as reason enough to reject the idea that you are an ethically coherent and emotionally literate human being. You have some ground to make up given our collective history. Likewise if you are a member of a political organisation that oversaw generations of state sanctioned abuse. And indeed this is also the case if you “believe” in unending economic growth on a planet of finite resources and growing inequality and social injustice. You simply come with too much baggage and too much incoherency to expect your ideas be deemed valid or socially useful merely because you hold them.

What come from this is the basis of a position that makes coherent arguments against state coercion in all its forms, but that also recognises that the state itself is deeply ideological itself, rather than an arbitrator. The tactic of mass civil disobedience has yet to be used within this wave of feminist struggle for social justice in the south. However when that happens, the state itself will be forced to act, and in doing so illuminate part of itself that so far has remained invisible in mainstream media narratives

Heres the letter

Open Letter

We, the undersigned, have either taken the abortion pill or helped women to procure the abortion pill in order to cause an abortion here in Northern Ireland.

We represent just a small fraction of those who have used, or helped others to use, this method because it is almost impossible to get an NHS abortion here, even when there is likely to be a legal entitlement to one.

We know that Stormont Ministers and the Public Prosecution Service are aware that such abortions have been taking place in the region for some years, but are unwilling to prosecute for a range of reasons, at least partly to do with not wanting an open debate around the issue of when women here should have a right to abortion.

We are publishing this letter now because of the Givan/Magennis amendment to the Criminal Justice Bill which we believe is aimed at closing down the debate on abortion here, as much as it is about closing down Marie Stopes.

We want to emphasise that medical abortions happen in Northern Ireland on a daily basis but without any medical support or supervision. We were delighted when Marie Stopes came to Belfast as it meant that women who are unwell, and therefore eligible for a legal abortion, can access a doctor to supervise what we have done or helped others to do without medical help.

We live in the only part of the UK that still does not have a childcare strategy. We face huge cuts in children’s living standards if the Assembly passes the Welfare Reform Bill without major amendment. If our politicians showed as much zeal in protecting the lives of children who are already born, perhaps we would have fewer women seeking abortion because of poverty.

Signed

Christiane McGuffin, Derry
Bronagh Boyle, Belfast
Goretti Horgan, Derry
Judith Cross, Belfast
Siusaidh Laoidhigh, Belfast
Roisin Barton, Derry
Virginia Santini, Belfast
Julia Black, Derry
Natalie Biernat, Derry
Adrianne Peltz, Bangor
Elizabeth Byrne McCullough, Belfast
Naomi Connor, Belfast
Catherine Couvert, Belfast
Caitlin Ni Chonaill, Belfast
Helen McBride, Armagh
Wendy McCloskey, Derry
Alice Lyons, Bangor
Maev McDaid, Derry
Janet Shepperson, Belfast
Mary Breslin, Derry
Anita Gracey, Belfast
Grainne Boyle, Belfast
Catherine Rush, Derry
Yvette Wilders, Limavady
Deirdre Kelly, Derry
Sarah Wright, Belfast
Sharon Meenan, Derry
Shannon O’Connell, Bangor
Ciara Smyth, Belfast
Shannon Sickels, Belfast
Jason Brannigan, Belfast
Connor Kelly, Derry
Claire Hackett, Belfast
James Doherty, Derry
Jill Letson, Derry
Noella Hutton, Derry
Glen Rosborough, Derry
Ann Harley, Derry
Ryan McKinney, Belfast
Kieran Gallagher, Derry
Jeanette Hutton, Derry
Julie Rogan, Derry
Matt Collins, Belfast
Pat Byrne, Derry
Susan Power, Derry
Aisling Gallagher, Belfast
Betty Doherty, Derry
Mel Bradley, Derry
Edward Gary Hill, Belfast
Sha Gillespie, Derry
Abby Oliveira, Derry
Joanne Butler, Derry
Majella Keys, Derry,
Gerard Stewart, Belfast
Maisie Sharkey, Derry
Orlagh Ni Leid, Belfast
M. Campbell, Derry
Tiarnan O Muilleoir, Belfast
Laura McFeely, Derry
Brenda Graham, Derry
Janet Shepperson, Belfast
Donna McFeely, Derry
Daisy Mules, Derry
Malachai O’Hara Belfast
Eileen Webster, Derry
Véronique Altglas, Belfast
Dianne Kirby, Derry
Helen Quigley, Derry
Sadie Fulton, Belfast
Aaron Murray, Derry
Aoife McNamara, Co.Down
Eileen Blake, Derry
Diana King, Derry
Paula Leonard, Killea
Kitty O’Kane, Derry
Sara Greavu, Derry
Eve Campbell, Derry
Katherine Rowlandson, Derry
Justine Scoltock, Derry
Eamonn McCann, Derry
Catrin Greaves, Belfast
Anita Villa, Derry
Caolan Brown, Derry
Asha Faria-Vare, Belfast
Chrissie Kavanagh, Derry
Elaine Power, Derry
Maria Caddell, Belfast
David Stewart Campbell, Lisburn
Ellie Drake, Belfast
Lisa Byrne, Derry
Siobhan Doherty, Derry
Stella Green, Belfast
Jim Collins, Derry
Guy Hetherington, Belfast
Amos Gideon, Belfast
Stephen Connolly , Belfast
Catriona Acherson, Belfast
Timothy Lavety, Belfast
Ellen Wilson, Belfast
Richard Bailie, Belfast
Manuela Moser, Belfast

The letter contains signatures of 100 individuals from Northern Ireland who have accessed or helped women to access illegal (under Section 58 of the Offences Against the Persons Act 1861) abortion pills, such as those available from Women on Web (WoW).

Update

Since the letter was published, the following names have been added:

Emma Campbell, Belfast
Judith Thurley BA (Hons) RGN, Belfast
Lynda Walker, Belfast
Claire McCann
Lily Hendron, Coleraine
Nick Ní Fhéasóg
Claire Molloy, Belfast
Peter McCormack, Belfast
Áine Jackman, Belfast
Seanín Ní Connalláin, Belfast
Ruth Wilson, Belfast

 

South America: Telephone hotlines mount fight against backstreet abortions

Mon, 25 Feb 2013 11:18 GMT

Source: Trustlaw // Anastasia Moloney

An activist dressed as a nun holds a placard that reads “they decided on your body” above pictures of the parliamentarians who are against abortion, during a rally outside a church in support of legalisation of abortion in Valparaiso city, about 121 km (75 miles) northwest of Santiago, September 28, 2012. REUTERS/Eliseo Fernandez

By Anastasia Moloney

BOGOTA (TrustLaw) – When Carolina answers an evening call in the Chilean capital of Santiago, she is acutely aware that she could be giving potentially life-saving information to a woman on the other end of the line.

Carolina is one of 30 self-described “militant feminist” volunteers who run an abortion hotline in Chile, providing information to women about how they can induce an abortion using the drug misoprostol.

The World Health Organisation recommends misoprostol, both taken on its own and combined with another drug mifepristone, as a safe and effective way for women to have an abortion in the first trimester of pregnancy.

In a country where abortion is a crime under any circumstances – even in cases of rape, incest or if the life of the mother or foetus is in danger – the hotline has become a lifeline, offering women a way to sidestep Chile’s blanket ban.

“Regardless of any laws, if a woman feels she needs an abortion she will get one. We know women in Chile have abortions every day. Abortion is a reality,” said Carolina, a volunteer at Lesbians and Feminists for the Right to Information, the Chilean group that runs the hotline.

“What we aim to do is to help women avoid having unsafe and clandestine abortions. The phone line is our strategy to fight that,” Carolina told TrustLaw in a phone interview in Santiago.

Originally invented as an ulcer drug, misoprostol induces an abortion by causing contractions of the uterus and is from 75 to 90 percent effective when taken correctly, WHO says.

Neither misoprostol nor mifepristone is risk-free and incomplete abortions can happen. But doctors say inducing an abortion with oral drugs rather than a surgical operation means it is less likely for an infection or a uterus perforation to occur.

UNSAFE ABORTIONS

In much of Latin America, Asia and Africa, restrictive laws or blanket bans on abortion force millions of women with unwanted pregnancies to have illegal and often unsafe abortions every year, according to WHO.

Some 47,000 women die from botched abortions each year around the world, says WHO. In Latin America meanwhile, deaths from botched abortions, often caused by severe bleeding, infections or a combination of both, account for 17 percent of maternal deaths in the region, the United Nations agency says.

That is why volunteers like Carolina are adamant it is vital to give women the information they need to stop preventable deaths from unsafe abortions.

“All women have the right to know about how to get a safe abortion,” Caroline, 32, said.

Since the hotline started in 2009, it has received more than 12,000 calls, up to 15 a day.

Sometimes it is a single mother of three who says she cannot afford to have another child. Other times, it is a young woman who does not feel ready to be a mother.

“We receive calls from young, old, poor, rich, married, single women, those with children and those without. Abortion is something that affects all kinds of women in Chile,” said Carolina, a sociologist.

Chile, like much of Latin America, is predominantly Catholic and the Catholic Church and conservative lawmakers argue that abortion infringes on the right of an unborn child, which should be protected by law at all costs.

Abortion, therefore, is both a taboo issue in Chile and a crime that can lead to imprisonment for those who perform abortions or assist on them. Because of this, hotline volunteers prefer to keep a low profile. They wear masks when promoting the hotline at public meetings and most choose not to give their full names.

It also means volunteers like Carolina are careful to only share public information with callers over the age of 18 based on a script approved by a lawyer.

“We don’t convince women to have an abortion. All women who call have already made up their minds to have an abortion,” said Carolina.

“We just provide women with information about how to have a safe abortion using misoprostol, correctly following WHO protocols.”

BLACK MARKET PILLS

On top of the country’s absolute ban on abortion, women in Chile face the additional challenge of getting hold of misoprostol.

The drug was pulled off pharmacy shelves in Chile, where it had been available with a prescription, under Michelle Bachelet, the former first female president of Chile, who now heads the U.N. Women’s agency.

It means women have to try their luck on the black market. It costs around $250 for the 12 pills needed for an abortion.

Chile’s safe abortion hotline was the brainchild of Dutch doctor and former Greenpeace activist, Rebecca Gomperts. Through her pro-choice group, Women on Waves, Gomperts has helped launch the abortion hotline in Chile, along with hotlines in Argentina, Ecuador, Peru and Venezuela.

“Medical abortion is such a revolution. Women …  can take their health, and life, in their own hands,” Gomperts told TrustLaw in an interview last year.

“PUSH AND PULL”

In Chile, any moves to decriminalise the country’s abortion laws are still a long way off, Carolina says.

“Chile is a very, very conservative country in all senses. The opinion of the Catholic Church holds a lot of weight in Chile. Maternity is seen as something sacred,” Carolina said.

“Currently, it’s not a priority among Chilean lawmakers to change the abortion laws and push for reform. Abortion isn’t an important issue in public debate.”

While there’s little headway on reproductive rights in Chile, elsewhere in Latin America attitudes have been changing.

In Colombia, for example, an absolute ban on abortion was partially lifted in 2006. A year later, abortion was made legal in Mexico City during the first 12 weeks of pregnancy and more recently last year in Uruguay.

“There’s a push and pull going on in Latin America,” Marianne Mollmann, a senior policy advisor on sexual and reproductive rights at Amnesty International, told TrustLaw.  “The countries that are stuck are Central America and Peru.”

As for Chile, the country remains a bastion for strict anti-abortion laws that force women to rely on underground activists and their telephone hotline to get a safe abortion.

 

 

Chile: Abortion Hot Line Is in Legal Gray Area

Taking Calls on Abortion, and Risks, in Chile  

 

By Aaron Nelsen   

Published: January 3, 2013  

http://www.nytimes.com/2013/01/04/world/americas/in-chile-abortion-hot-line-is-in-legal-gray-area.html?pagewanted=all&_r=1& 

  

Roberto Candia for The New York Times

Volunteers for the Safe Abortion Hot Line in Chile routinely wear masks when showing support in public for the organization in a country where abortion is illegal under any circumstances.

 

SANTIAGO, Chile – Every time the phone rings, Angela Erpel feels her nerves swell. Sometimes it is a scared teenager on the other end, or a desperate mother of three. There are the angry ones, too, with callers playing the sounds of crying babies or sending text messages with pictures of aborted fetuses.  

 

Then Ms. Erpel, 38, a sociologist who volunteers at Chile’s Safe Abortion Hot Line, gathers herself and settles into a familiar dialogue on the use of misoprostol, a drug that will induce a medical abortion.

 

“We don’t give them a moral guide or advice; we only provide information,” she said.

 

Since the hot line began in 2009, volunteers spread across this long, thin country have taken turns answering tense calls from women seeking information about abortion every evening from 7 p.m. to 11 p.m. There have been more than 12,000 calls so far, and they continue rolling in at a steady clip.

 

In a country where abortion is entirely illegal, even in cases of rape or when a woman’s life is in danger, the hot line is a risky endeavor. Operating in a legal gray area, volunteers face a daunting prison sentence if a conversation veers too far from a lawyer-approved script. The hot line already has had three lawsuits brought against it, though all were eventually dropped.

 

According to the law, having an abortion carries a penalty of 5 to 10 years in prison, depending on the circumstances, while doctors and others who perform an abortion or assist with one could face up to 15 years, prosecutors say. In practice, however, fewer than 500 cases have been prosecuted over the last several years.

 

“I think there is a certain sensitivity to the social conditions behind these abortions, such as poverty or rape or teenage pregnancy,” explained Paula Vial, a lawyer and former public defender in Santiago.

 

Beyond the legal consequences, the 30 hot line volunteers are keenly aware of the social ramifications of taking an active role in such a polarizing issue. They wear masks when promoting the hot line at public gatherings, and are often vague about the details of their volunteer work in their daily lives. Many fear losing their jobs or driving a wedge into personal and family relationships. Indeed, Ms. Erpel was the only volunteer willing to go on the record about her work with the hot line, and even she is usually circumspect about it.

 

“It’s complicated,” she explained. “I’m open about being in an organization, but not necessarily that I work directly with abortion.”

 

Abortion was not always a clandestine affair in Chile. The current law that strictly bans it was one of the final acts of the dictatorship. In 1989, shortly before relinquishing power, Gen. Augusto Pinochet ended a tradition of legal abortion dating to 1931, in which a pregnancy that threatened a woman’s life, or a fetus that was not viable outside the womb, could be terminated. Chile’s law now is one of the strictest in the world.

 

By contrast, Uruguay legalized abortions in the first trimester for any reason last October, joining Guyana and Cuba as Latin American countries with broadly legalized procedures. Abortion is also legal in Mexico City. But Chile has remained a socially conservative country, after 20 years of economic growth and the election in 2006 of a woman as president.

 

“The hierarchy of the Catholic Church has had a very strong influence in public policy,” said Claudia Dides, a spokeswoman for the Movement for the Legal Interruption of Pregnancy.

 

In a pivotal case in 2008, Karen Espíndola, then 22, learned in her 12th week of pregnancy that her fetus had holoprosencephaly. Fetuses with the condition have a single-lobed brain, and most die before they are born. It is a common reason for terminating a pregnancy.

 

Ms. Espíndola sought an abortion, appealing to the president and setting off a national conversation over abortion. In February 2009, Ms. Espíndola gave birth to Osvaldo, who died in 2011.

 

“In reality he was never conscious he was alive,” she lamented. “He fought to breathe; he was fed through a tube. We all suffered a lot. Nobody here is a winner.”

 

Chile has witnessed a swell of liberal social movements in recent years, with gay men and lesbians pressing for the country’s first hate-crime legislation, environmentalists stalling dam-building projects in Patagonia, and students pushing for an overhaul of the education system.

 

Advocates contend that abortion rights sentiment bubbles near the surface as well, but the government has pushed back.

 

After criticizing the abortion hot line in the news media, the Ministry of Women started a hot line of its own. It is attended by psychologists and social workers who answer calls from men or women looking for information or support when facing what the ministry calls an “abortion situation” or “post-abortion syndrome.”

 

“Maternity, one of the most satisfactory experiences in the life of a woman, can go through difficult and desperate moments,” Minister Carolina Schmidt said at the time the government hot line began.

 

Other influential anti-abortion organizations offer to guide women considering abortion away from the procedure.

 

“If you help that person define what is troubling them and making them think of an abortion, and together you find a solution, in the end the person decides for life and her child,” said Victoria Reyes, director of assistance for Foundation Chile United. “We are convinced the second victim of abortion is the woman; the woman who has an abortion carries that guilt.”

 

The government reported several hundred adoptions in 2011, but it estimates 120,000 abortions, in a country with a population of about six million women from 15 to 64 years old.

 

Misoprostol, sold under the brand name Misotrol in Chile, has changed the way many of those abortions are performed. The drug was originally developed as an ulcer medication, and its warning label advised that, in excess, misoprostol would cause a woman to miscarry. Before long, women in countries with little or no access to safe abortions were using the drug to do that very thing.

 

Misoprostol “is a revolution for women,” said Rebecca Gomperts, founder of the Dutch organization Women on Waves. “Even where abortion is illegal and women don’t have a doctor, or they are poor, they still have a way to do a safe abortion.”

 

The abortion hot line is Ms. Gomperts’s creation. A medical doctor and former Greenpeace activist, she realized in 1999 that it was possible for a ship sailing under a Dutch flag to take women from countries where abortion is illegal to international waters to administer misoprostol.

 

Before departing Chile, Women on Waves helped set up the abortion hot line, training volunteers how to discuss misoprostol according to World Health Organization guidelines.

 

There are now five abortion hot lines in South America: in Argentina, Chile, Ecuador, Peru and Venezuela.

 

Misoprostol was taken off pharmacy shelves in Chile under Michelle Bachelet, the former president who now runs the United Nations’ agency for women’s advancement, so access to the drug is almost entirely a black market transaction.

 

Dozens of Web sites offer misoprostol at exorbitant prices, and sometimes of dubious quality.

 

One 29-year-old lawyer who became pregnant a few months ago said she paid $300 for the necessary 12 pills.

 

“To meet someone in a clandestine place, hoping they aren’t a police officer, wondering if they are even giving you the right pills, knowing that you could go to prison when all you want to do is exercise your right as a woman is horrifying,” the lawyer said on the condition of anonymity to avoid prosecution.

To its volunteers, the Safe Abortion Hot Line stands as a simple equation – 30 women and a single cellphone that gets passed among them. This month, they expanded: they released an abortion manual on using misoprostol.

 

Occasionally, women call back the hot line after a successful abortion, but more often the volunteers never know the outcome.

 

“That’s always the hardest part,” Ms. Erpel said.  

 

Kenya: “It was worth the sacrifice”: Kenya’s Dr. John Nyamu on why he spent a year in prison

http://www.ipas.org/~/media/Files/Ipas%20Publications/MAMattersNov2012.ashx

 

PERSPECTIVES: ‘It was worth the sacrifice’: Kenya’s Dr. John Nyamu on why he spent a year in prison

 

From: Ipas, Medical Abortion Matters (November 2012)

 

Until 2011, abortion was illegal in Kenya except to save a woman’s life. For years the climate of fear and secrecy surrounding abortion hurt women, their families, and health-care providers. Unsafe abortion in Kenya still causes an estimated 30 percent of maternal deaths and countless other injuries.

 

Now, a newly ratified Kenyan constitution allows for legal abortion on much broader terms-and, when the new law is fully implemented, it stands to dramatically increase women’s ability to exercise their reproductive rights.

 

Ipas’s senior clinical advisor Mary Fjerstad recently sat down with Kenya’s much-respected Dr. John Nyamu to discuss the long and difficult path he and so many other Kenyans have traveled to get where they are today.

 

Mary Fjerstad: Doctor Nyamu, would you tell me what the situation was like in Kenya when abortion was considered a criminal act? [Editor’s note: Before constitutional reform, abortion in Kenya was highly restricted with few legal indications for having the procedure.]

 

Dr. John Nyamu: Most health-care workers were afraid of talking about it openly. Abortion was never performed in government hospitals unless the life of the woman was in real danger. Even then it was very bureaucratic as one doctor could only do the procedure with permission in writing from two other doctors; one doctor had to be a psychiatrist and the other doctor had to be a senior doctor in the hospital. Abortions were performed by D&C or induction. In reality, these legal abortions were provided almost exclusively at Kenyatta National Hospital, provincial hospitals and very rarely in district hospitals. (Kenyatta National Hospital is the major teaching hospital in Nairobi).

T

here were wards in hospitals where women who had unsafe abortions were treated for uterine and bowel damage due to perforations and developed sepsis, brain damage and many women died.

T

here was tremendous secrecy about abortion, women were aborting late. The penalty for a doctor who performed an [illegal] abortion was 14 years [in prison]; pharmacists could be imprisoned for three years for giving abortifacient medicines and women themselves could be imprisoned for seven years for having an abortion.

 

Some private clinics were providing safe abortion. They were harassed regularly by local police, usually by extortion. They were used virtually as the personal ATMs of the police [ATM = Automatic Teller Machine, a banking machine from which you can withdraw cash using a bank card]. A policeman would say, “I’m short of cash, give me your cash or I’ll arrest you.” The entire staff, including nurses, doctors and women seeking abortion could be arrested. Due to the fear, the providers kept servicing [the police] to buy their freedom.

 

Your case was profiled by The Center for Reproductive Rights’ paper in 2010, “In Harm’s Way: the Impact of Keny’s Restrictive Abortion Law.” Can you briefly describe what happened to you that led to this paper?

 

In 2004, [data were shared] which showed worrying trends and consequences of unsafe abortion in Kenya. This was followed by a major crackdown on clinics, hunts for women who had abortions, some clinics were closed and I was targeted. There were 15 fetuses found along a major road with some documents from a hospital I had worked at previously but had since closed. My clinic was raided and two nurses and I were arrested. This appeared to have been very well organized with all the media including print, radio and TV present to report on the matter.  When we were asked to pay bribes, we refused-because we knew the fetuses were not from our clinic and the documents were planted on the road-and we were locked up. [Editor’s note: subsequent pathology examinations found that the fetuses were still-born fetuses, not aborted fetuses.]

 

The three of us were ultimately charged with two counts of murder, rather than an abortion-specific offense. Since murder is a non-bailable offense in Kenya, we had to stay in remand prison pending our trial. We all spent a year in prison. One of the nurses was six months pregnant and delivered while she was in prison. One of the nurses still works for me and the other got her green card and has since immigrated to the United States.

 

A senior doctor, a gynaecologist, was instructed by the Director of Medical Services of the Ministry of Health to accompany the police and inspect the two clinics operated by Reproductive Health Services. The purpose of the inspection was to verify if there was any abortifacient equipment. He gave witness in court that the two facilities had legal equipment normally found in a gynecologist’s clinic and he would be surprised if he did not find it as he uses the same equipment for his work. The police forensic department was asked to look for DNA on the equipment from the clinic. DNA was taken from any instruments or equipment with blood on them-even the couches and lab coats were confiscated. The results from the government chemist found that there was no DNA linkage between the fetuses found on the road and any blood specimens from the clinic. The doctor also found that the clinic was duly registered and all staff had proper and up-to-date licenses.

 

The case was eventually ruled as improper [Editor’s note: They were acquitted of all charges]. With that ruling, the attorney general decided not to pursue prosecution due to lack of evidence.

 

Was it horrible being in prison for a year?

 

Yes, it was horrible, but it was worth the sacrifice. I was held at the Kamiti Maximum Prison, which is where the hard-core criminals are remanded. I was confined in a small cell for a whole year. I really felt persecuted, but as I said, it was worth the sacrifice.

 

Why do you say it was worth the sacrifice?

 

My arrest and imprisonment was in the media virtually every day. The publicity was an opening for people to realize the magnitude and consequences of unsafe abortion in Kenya; women were dying in great numbers. Before that, abortion was never spoken of in public. There are only about 250 OB/GYNs in Kenya; some districts have none. The media sensation from this case galvanized the Kenya Obstetrical and Gynaecological Society (KOGS), the National Nurses Association of Kenya, the Federation of Women Lawyers, human rights advocates, women’s rights organizations and many others to form an alliance of reproductive health rights advocates.

 

This alliance exists to date and is known as the Reproductive Health and Rights Alliance (RHRA). The RHRA is an advocacy platform to agitate for the reduction of maternal mortality and morbidity due to unsafe abortion. This alliance also offers technical support to abortion service providers through Reproductive Health Network (RHN). The public became aware of abortion and the toll of unsafe abortion. The window was open to the public to realize the terrible toll of unsafe abortion in Kenya.

 

This debate extended to the drafting of a new Constitution in 2010. The Constitution says that “every person has the right to the highest attainable standard of health, which includes the right to health care services, including reproductive health care.” My arrest, imprisonment and [the resulting] publicity generated a public awareness that led to a transformation in the understanding that safe abortion is essential to preventing maternal morbidity and mortality.

 

Is there any further action in your own case?

 

Yes, I have since sued the government for malicious prosecution and subsequent confinement for one year in remand prison. The case has been in court for the last six years without yet being assigned a hearing.

 

What does the expansive definition of health in the new constitution mean in terms of when an abortion is considered legal?

 

Abortion is legal if the pregnancy endangers the life of the woman; as an emergency treatment; or when it endangers health, with health defined broadly: physical, social and mental. If in the opinion of a trained health professional an abortion is provided in good faith (in other words, where the pregnancy jeopardizes the woman’s physical, social or mental health), it is legal. [Editor’s note:Under the new law, a woman can make her abortion decision with one health-care provider; others are not required to be involved or sign off on the decision.]

 

What categories of health-care providers can perform legal abortion?

 

Physicians, nurses, midwives and clinical officers [who have completed training to perform abortion services] can now perform legal abortions.

 

What are the next steps in transforming the policies to establish safe, legal abortion in Kenya?

 

Ipas and other organizations took the lead in writing a document called, “Standards and guidelines for reducing morbidity and mortality from unsafe abortion.” The title is taken from a similar document from Zimbabwe and is brilliant. Kenya, like other countries, wants to achieve the Millennium Development Goal of 75-percent reduction in maternal mortality; this can’t be achieved if safe abortion isn’t available.

 

The other milestone on transformation is the revision of codes of ethics and scope of practice for all the professional associations in Kenya. These have been done and are waiting to be launched.

 

This transformation to legal abortion access in Kenya is a testament to very brave, inspired people dedicated to the common good who have sacrificed a lot. How have all the changes we’ve discussed affected providers of safe abortion and women?

 

Providers are now aware of the enhanced protections that have been offered by the constitution. This in turn has increased access to safe abortion services and thereby enabled women to realize their reproductive health rights. In addition, incidences of provider harassment are now on the decrease.